J Korean Orthop Assoc.  2007 Feb;42(1):141-145. 10.4055/jkoa.2007.42.1.141.

Delayed Repair with Augmentation using Achilles Allograft of Old Ruptured Patellar Tendon after Revison Total Knee Arthroplasty: A Case Report

• Ha CW
• Yu KS

• KMID: 2106388
• DOI: http://doi.org/10.4055/jkoa.2007.42.1.141

Abstract

The rupture of the patellar tendon after total knee arthroplasty (TKA) is rare but serious complication resulting in a severe dysfunction in the extension mechanism. There are a few reports on the treatment of this condition. However, there is still some controversy regarding the choice of proper management. There is no report of the patellar tendon augmentation or reconstruction in this condition in the Korean literature. We report a case of an old patellar tendon rupture in 70-year old patient that occurred at 5 months after a two stage revision for an infected TKA and was treated satisfactorily by delayed repair with augmentation using an Achilles allograft.

Keyword

Knee; Revision total knee arthroplasty; Patellar tendon rupture; Patellar tendon augmentation; Achilles allograft

MeSH Terms

Aged
Allografts*
Arthroplasty*
Humans
Knee*
Patellar Ligament*
Rupture

Figure

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  Fig. 1 (A, B) The immediate postoperative radiographs after revision total knee arthroplasty showing good alignment and no patellar alta. (C) The radiograph at 5 months postoperatively showed an anterior dislocation of the knee. (D) The radiograph after the reduction of the knee showed patella alta.

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  Fig. 2 The patient showed extension lag 90° preoperatively.

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  Fig. 3 (A) The patellar tendon was ruptured at the attachment site of tibial tuberosity. The distal portion of ruptured patellar tendon is connected with stretched fibrous scar tissue. (B) Modified Krackow's suture was applied to patellar tendon portion. The quadriceps-patella-patellar tendon complex was pulled down to the tuberosity area and secured under tension by passing the suture arms through the bony tunnel made at the tuberosity. (C) A rectangular bony trough was made at the proximal-medial aspect of the tibia. (D) The allograft was sutured to the underlying quadriceps tendon, soft tissue around the patella and patellar tendon with multiple nonabsorbable sutures.

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  Fig. 4 The radiographs and clinical photographs at the 3 years follow up after the reconstruction of the patellar tendon. (A) AP and (B) lateal radiographs showed a well integrated allograft. The clinical photographs showed active full extension (C) and 130 degree of active flexion (D) of the right knee.

Reference

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